What you eat can have a large impact on the severity of the pain and discomfort you experience due to chronic pelvic pain. In fact, nutrition is one of the top modifiable lifestyle factors for chronic non-communicable conditions such as chronic pelvic pain. Unfortunately, people who experience chronic pelvic pain are more likely to be malnourished or experience under-nutrition due to poor appetite, fatigue or other disabling issues, which in itself can contribute to more pain.
Rather than seeing diet as a cure for chronic pain, we need to see it as an evidence-based therapy that is one piece of the puzzle to helping a person reduce the severity of their chronic pelvic pain and meet their daily nutrition needs. Dietary changes need to be realistic and easy to implement, whilst taking a flexible approach to nutrition to best adapt to the ups and downs of life. When I work with clients who take this approach, people are able to reduce their pain, increase their energy, improve their mental health and overall quality of life, helping them get back to doing the things in life they want to do!
In this blog, we will explore the connection between nutrition and chronic pelvic pain and provide valuable insights into how dietary choices can contribute to a more holistic approach to chronic pelvic pain management. If you or someone you know is experiencing chronic pelvic pain, I hope you find this blog helpful.
What is chronic pelvic pain (CPP)?
Chronic pelvic pain is intermittent or constant lower abdominal pain that occurs for longer than 6 months ¹. It occurs outside of menstruation or intercourse and is not associated with pregnancy 2. Chronic pelvic pain affects 6 – 27% of women,3 with endometriosis being the most common cause of chronic pelvic pain 4. CPP arises from structural changes within the pelvis due to gynaecological, gastrointestinal, urinary or neurological causes (See below*).
Often the cause of pelvic pain is because of different conditions that overlap in symptoms. This makes it difficult to diagnose, and people commonly report needing to see multiple specialists before getting some answers or substantial relief. To add into the mix, musculoskeletal changes are common (no matter the original cause) and these too may contribute to pain. Unfortunately, this restricts a person’s quality of life and ability to complete daily tasks, which understandably goes on to impact their mental wellbeing. Many people also report using prescription medications such as analgesics and non-steroidal anti-inflammatories to relieve pain.
*Common causes of CPP
Gynaecological conditions: endometriosis, adenomyosis, adhesions, chronic pelvic inflammatory diseases, remnant ovary syndrome, trapped ovary syndrome or pelvic congestion syndrome.
Gastrointestinal conditions: irritable bowel syndrome, inflammatory bowel disease and coeliac disease.
Urinary conditions: bladder pain syndrome or urethral syndrome.
Neurological conditions: pudendal neuralgia, trigger points or nerve entrapment.
What should I eat to help reduce chronic pelvic pain?
What you should eat really depends on the person and their cause of the chronic pelvic pain. The cause and food triggers for pain vary from person to person. This is why working with an accredited practising dietitian who specialises in women’s health like Dr Stephanie Pirotta is an important part of your healthcare team. In saying this, there are general tips and nutrient recommendations that are important for all people experiencing chronic pelvic pain.
Adequate carbohydrates and protein, especially if fatigued or nauseated
Some people experience nausea and fatigue to the point that they are unable to stomach food or even get off the bed or couch, let alone prepare a meal. The underlying cause of nausea is complex, involving the central nervous system, autonomic nervous system, gastric dysrhythmias, psychological state and the endocrine system 5. When this happens, people may:
(1) Eat balanced meals but not frequently enough to meet their nutritional needs
(2) Barely eat but when they do, they choose the higher energy, nutrient-poor foods which are quick and easy to make or are easy to order online
Either way, requirements of lean proteins, healthy fats, complex carbohydrates and fibre are not met which means daily requirements of vitamins and minerals like vitamin Bs, zinc, folate, vitamin C and omega-3s (to name a few) fall by the wayside. Over time, this increases risk of malnutrition, coupled with loss of muscle mass, which is important for your overall metabolic health and risk of disease. This can happen to anyone who does not eat well, no matter your body size.
When working with someone with limited intake, the first step is to help increase overall nutrition in a safe and gradual manner that is not going to make them feel sicker or is too daunting. Here are some tips to help you increase your food intake and reduce nausea and fatigue:
1. Eat bland foods. E.g. basmati rice, bananas, cooked and skinless chicken, wholemeal or wholegrain bread, sweet potatoes, apple puree.
2. Eat or drink more ginger. Ginger (Zingiber officinale) is an ancient herb used for its natural medicinal properties to safely and effectively relieve nausea by increasing gastric tone and motility and gastric emptying 6. Suck on ginger ice chips, sip on ginger tea, or enjoy carrot and ginger soup.
3. Eat smaller and more frequent meals. Aim for 6-8 small meals per day rather than larger meals. Having regular big snacks is less load on the stomach and reduces gastric volume. Having something regularly in your stomach also helps prevent gastric acid build up, which on an empty stomach can make the nausea worse.
4. Eat your food either cold or lukewarm. Hot food increases in smell and can make the nausea worse. Leave the food to cool down once cooked or heated for 10 minutes before eating it.
5. Drink after eating, not before or during. Having too much in your stomach may cause nausea. Water or other low nutrient drinks can take up the limited volume in your stomach, displacing your food.
Foods that follow an anti-inflammatory diet
Eating an anti-inflammatory diet rich in fruits, vegetables, whole grains, lean proteins and healthy fats can help reduce inflammatory markers in the body, which have been linked to chronic pain 7. Incorporating foods with omega-3 fatty acids, such as fatty fish (salmon, mackerel, sardines), flaxseeds, and walnuts, can have beneficial effects 7. This type of diet is rich in resveratrol, polyphenols, phytoestrogens, omega-3, vitamin C and vitamin A and vitamin C, whilst being high in fibre and low in saturated fat. Some types of anti-inflammatory diets are the Mediterranean Diet or the Dietary Approaches to Stop Hypertension (DASH) diet which have several overlapping principles 8. How these may be applied in day-to-day life are different for each person, considering personal dietary preferences, food intolerances or allergies, cultural backgrounds, available resources and finance. Working with your women’s health dietitian is the best way to gain evidence-based information and personalised dietary recommendations that meets your needs.
Foods that promote regular bowel movement – like fibre!
Many individuals with chronic pelvic pain also have underlying gastrointestinal issues like irritable bowel syndrome (IBS). Eating an adequate amount of dietary fibre can support digestive health, regulate bowel movements and potentially reduce discomfort associated with constipation. Whole grains, fruits, vegetables and legumes are excellent sources of dietary fibre.
People with chronic pelvic pain however commonly report feeling bloated and sensitive to high-fibre foods, especially lentils and legumes! You need to balance getting enough fibre with the right type that isn’t going to give you an upset stomach and make you feel even worse! Working with your women’s health dietitian, you can slowly increase fibre into your diet to better your bowel and gut health, whilst slowly getting your digestion system used to breaking down more fibrous foods in a safe, pain-free way. Just FYI, you don’t normally need to go on a low FODMAP diet! Even if you do, it should be no more than 6 weeks.
Foods that optimise your gut health
Gut health has been linked to various chronic pain conditions. Probiotics, found in foods like yogurt, kefir, sauerkraut, and kimchi, can support a balanced gut microbiome, potentially reducing symptoms in people who experience PPP.
Foods that reduce bladder irritation
Eating foods that are high in anti-inflammatory properties like vitamins A, C, D, and E whilst reducing acidic foods which are known to irritate the bladder are recommended. Acidic foods may include tomatoes and alcohol.
Consider sensitivities like wheat, dairy and high-FODMAP foods
Some individuals with CPP may benefit from trying elimination diets to identify potential trigger foods that worsen their symptoms. Common culprits include gluten, dairy, and certain high-FODMAP foods. Working with a registered dietitian can help you safely navigate what periodic elimination may look like for you, if you need it.
Water: not a food, but important to stay hydrated!
Staying adequately hydrated is crucial for overall health and can potentially alleviate certain symptoms of CPP. Water helps maintain optimal digestion, regulate body temperature, and support various bodily functions.
Conclusion
While nutrition isn’t a stand-alone solution for chronic pelvic pain, its impact on overall health and inflammation levels can significantly contribute to symptom management and improved quality of life. A balanced, anti-inflammatory diet rich in nutrient-dense foods, mindful eating practices, and targeted strategies like elimination diets and probiotics can play a vital role in managing CPP.
Remember, every individual’s body is unique, and what works for one person might not work for another. If you’re considering making significant dietary changes to manage chronic pelvic pain, contact your women’s health registered dietitian like Dr Stephanie Pirotta at Womanly Nutrition and Dietetics who operates at the Maven Centre at Sunshine Private Hospital Melbourne who can tailor recommendations to your specific needs. By adopting a holistic approach that combines medical treatment, proper nutrition, stress management and self-care, you can take positive steps toward alleviating chronic pelvic pain and improving your overall well-being
References
[1] Howard F, Perry P, Carter J, El-Minawi A (2000) Lippincott Williams and Wilkins, Philadelphia.
[2] Kennedy S, Moore J (2006) Royal College of Obstetricians and Gynaecologists, London.
[3] Ahangari A (2014) Prevalence of chronic pelvic pain among women: an updated review. Pain Physician 17, E141-147.
[4] Hickey M, Ballard K, Farquhar C (2014) Endometriosis. BMJ : British Medical Journal 348, g1752.
[5] Singh P, Yoon SS, Kuo B (2016) Nausea: a review of pathophysiology and therapeutics. Therap Adv Gastroenterol 9, 98-112.
[6] Lete I, Allué J (2016) The Effectiveness of Ginger in the Prevention of Nausea and Vomiting during Pregnancy and Chemotherapy. Integr Med Insights 11, 11-17.
[7] Dragan S, Șerban MC, Damian G, Buleu F, Valcovici M, Christodorescu R (2020) Dietary Patterns and Interventions to Alleviate Chronic Pain. Nutrients 12.
[8] Piecuch M, Garbicz J, Waliczek M, Malinowska-Borowska J, Rozentryt P (2022) I Am the 1 in 10—What Should I Eat? A Research Review of Nutrition in Endometriosis. Nutrients 14, 5283.
